Opiates such as heroin can quickly produce physical addiction. As the substances are expensive and can often be only obtained illegally, opiate addiction causes many problems in coping with everyday life and can lead to social isolation and even a life of crime. For many addicts, the only way out of this situation is substitution treatment, in which the actual drug is replaced by substitutes such as methadone or buprenorphine under medically controlled conditions.

However, Prof. Dr. Gundula Barsch explains that there are only about 3,000 substitution doctors for 80,000 substitution patients in Germany. The social scientist from Merseburg University of Applied Sciences coordinates the Checkpoint-S project and is developing an app that offers people in substitution treatment some kind of “help for self-help”. The app is not only intended to reduce the care gap, but also the typical power gap between doctor and patient: “We all know the feeling of not always being able to talk to the doctor at eye level,” she says, “For opiate addicts, this gap is even greater because they are an extremely stigmatised group that is often considered loud, dirty, criminal and difficult to treat, even among doctors”.

Digital diaries provide insights into your own illness

It is indeed often difficult for addicts to keep their lives under control, even in substitution treatment: problems or stress can quickly upset the fragile balance. This is exactly where Checkpoint-S comes in. The app offers users various diaries to document the use of the substitution drug and its consumption, or to record consumption pressure and changing moods. “If you superimpose such diaries, you get interesting insights into your own illness,” explains Gundula Barsch. For example, substitution patients find out which external influences cause them to feel pressure to consume drugs or whether the dose of their substitution drug is too low. Thanks to the graphic evaluations, they also have a better basis for argumentation with their doctor. According to Barsch, the aim is a treatment in the spirit of “Shared Decision Making”, in which doctor and patient work together to find the best therapy. Substitution patients are often still “light years away” from this goal, she says.

Gundula Barsch also emphasizes that the app is made for the patients - not for the practitioners. “Of course, we involve doctors and other practitioners in the development process and ask them for their opinion,” she says, “but if their wishes and those of the patients clearly diverge, then we decide on the wishes of the patients.” Among other things, all data is stored locally on the patient's own device. Users can share their records with their doctor, but they don't have to.

The conceptual approach of Checkpoint-S provides users with a degree of autonomy and self-efficacy that they rarely experience otherwise, says Barsch. She points out that external circumstances often put substitution patients into situations that make them conspicuous. For example, in sparsely populated areas, where they often have to travel long distances by public transport to reach the nearest substitution practice: The treatment times for substitution patients are usually scheduled early in the morning to separate them from other patients. So, what do you do if the next bus home does not leave until hours later? You will probably wait in the city centre or near the practice - and the prejudice of a loitering junkie is confirmed.

Early start of the app because of Corona

The corona crisis has worsened the situation for substitution patients - as for so many people on the margins of society - and has also forced the Checkpoint-S team to take special measures. With the beginning of the crisis, the team accelerated its work on various features, and new functions were made available to all interested parties in order to alleviate the tense supply situation for the patients.

The lockdown suddenly led to the closure of practices and facilities, and instead of the strictly controlled daily distribution of substitution products at the doctor's, the take-home principle was expanded: patients could take home larger quantities of their medication. “Most patients were completely left to their own devices in this situation,” says Barsch, “and we wanted to give them at least a little guidance with the early version of the app.”

The current user figures show that this has obviously worked out quite well: By the end of August, 500 people had already downloaded the app from the respective app stores, and there is also a download link on the project website. A feedback system on the same website ensures that all users are involved in the further app development - not just those who were approached as contributors at the start of the project.

Currently, the aim is to link the data from the diaries with a coaching system. Push notifications should encourage users to make regular entries and to look into their statistics. At the express request of patients, a module has just been completed that allows them to define their own goals, for example in terms of sleep, sports or nutrition.

Health apps are available for many target groups, but not for addicts

Health apps are currently on the rise, but Checkpoint-S is the only one that specifically targets opiate addicts. A total of three scientists at Merseburg University of Applied Sciences are involved in the project; Curamatik GmbH, a spin-off of the TU Berlin, is in charge of programming. The project team recruits test persons from various drug counselling centres and substitution practices, including in Berlin and Halle, to test the new functions of the app.

Although Checkpoint-S got off to a surprisingly good start in the crisis, some questions still worry project manager Gundula Barsch: How can the team carry out the urgently needed usability tests with as little contact as possible and still be able to talk to the users? And what is the best way to promote the app during these troublesome times?

Originally planned activities such as workshops and practice visits had to be cancelled this year due to the Corona measures. So how do you reach more patients, and above all: how do you reach their doctors? It is precisely these doctors who are often reluctant to take advantage of this new technical possibility, reports the scientist: “Many doctors have never included apps in their treatment and are therefore sceptical about the possible benefits for the treatment”. However, the possibilities opened to them by the evaluation of their patients' everyday data have so far convinced all doubters.